DMEK under PKP Using a Modified Jones Tube Glass Injector

We have found that DMEK under PKP can work well if the PK wound architecture is good and doesn't contain ridges and folds that can interact unfavorably with adhesion. It is also important to rule out anterior stromal scarring in the PK graft that could limit visual recovery with an endothelial transplant--these patients are probably better served with a repeat PKP.

We have also found that DMEK grafts undersized by 1 mm smaller than the PKP diameter fit well within the confines of the PK wound. The smaller the graft, the fewer the cells and likely the shorter its life. We don't know whether a large graft draping over the PKP wound would adhere well or not.